磁共振血管造影在脑动静脉畸形和硬脑膜动静脉瘘诊断中的应用：时间分辨磁共振血管造影与三维时间飞跃磁共振血管造影的比较
Magnetic Resonance Angiography in the Diagnosis of Cerebral Arteriovenous Malformation and Dural Arteriovenous Fistulas: Comparison of Time-Resolved Magnetic Resonance Angiography and Three Dimensional Time-of-Flight Magnetic Resonance Angiography.
作者信息
Cheng Yu-Ching, Chen Hung-Chieh, Wu Chen-Hao, Wu Yi-Ying, Sun Ming-His, Chen Wen-Hsien, Chai Jyh-Wen, Chi-Chang Chen Clayton
机构信息
Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan.
Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Medical Imaging and Radiological Sciences, Central Taiwan University of Science and Technology, Taichung, Taiwan.
出版信息
Iran J Radiol. 2016 Mar 28;13(2):e19814. doi: 10.5812/iranjradiol.19814. eCollection 2016 Apr.
BACKGROUND
Traditional digital subtraction angiography (DSA) is currently the gold standard diagnostic method for the diagnosis and evaluation of cerebral arteriovenous malformation (AVM) and dural arteriovenous fistulas (dAVF).
OBJECTIVES
The aim of this study was to analyze different less invasive magnetic resonance angiography (MRA) images, time-resolved MRA (TR-MRA) and three-dimensional time-of-flight MRA (3D TOF MRA) to identify their diagnostic accuracy and to determine which approach is most similar to DSA.
PATIENTS AND METHODS
A total of 41 patients with AVM and dAVF at their initial evaluation or follow-up after treatment were recruited in this study. We applied time-resolved angiography using keyhole (4D-TRAK) MRA to perform TR-MRA and 3D TOF MRA examinations simultaneously followed by DSA, which was considered as a standard reference. Two experienced neuroradiologists reviewed the images to compare the diagnostic accuracy, arterial feeder and venous drainage between these two MRA images. Inter-observer agreement for different MRA images was assessed by Kappa coefficient and the differences of diagnostic accuracy between MRA images were evaluated by the Wilcoxon rank sum test.
RESULTS
Almost all vascular lesions (92.68%) were correctly diagnosed using 4D-TRAK MRA. However, 3D TOF MRA only diagnosed 26 patients (63.41%) accurately. There were statistically significant differences regarding lesion diagnostic accuracy (P = 0.008) and venous drainage identification (P < 0.0001) between 4D-TRAK MRA and 3D TOF MRA. The results indicate that 4D-TRAK MRA is superior to 3D TOF MRA in the assessment of lesions.
CONCLUSION
Compared with 3D TOF MRA, 4D-TRAK MRA proved to be a more reliable screening modality and follow-up method for the diagnosis of cerebral AVM and dAVF.
背景
传统数字减影血管造影（DSA）是目前诊断和评估脑动静脉畸形（AVM）和硬脑膜动静脉瘘（dAVF）的金标准诊断方法。
目的
本研究旨在分析不同的微创磁共振血管造影（MRA）图像，即时间分辨MRA（TR-MRA）和三维时间飞跃MRA（3D TOF MRA），以确定它们的诊断准确性，并确定哪种方法与DSA最为相似。
患者和方法
本研究共纳入41例初次评估或治疗后随访的AVM和dAVF患者。我们应用使用锁孔技术的时间分辨血管造影（4D-TRAK）MRA同时进行TR-MRA和3D TOF MRA检查，随后进行DSA检查，DSA被视为标准参考。两名经验丰富的神经放射科医生对图像进行了审查，以比较这两种MRA图像之间的诊断准确性、动脉供血和静脉引流情况。通过Kappa系数评估不同MRA图像的观察者间一致性，并通过Wilcoxon秩和检验评估MRA图像之间诊断准确性的差异。
结果
使用4D-TRAK MRA几乎可以正确诊断所有血管病变（92.68%）。然而，3D TOF MRA仅准确诊断了26例患者（63.41%）。4D-TRAK MRA与3D TOF MRA在病变诊断准确性（P = 0.008）和静脉引流识别（P < 0.0001）方面存在统计学显著差异。结果表明，在病变评估方面，4D-TRAK MRA优于3D TOF MRA。
结论
与3D TOF MRA相比，4D-TRAK MRA被证明是诊断脑AVM和dAVF更可靠的筛查方式和随访方法。
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